A retrospective cohort study of delivery outcomes after use of outpatient misoprostol for the induction of labor.

The objective of this study was to examine the effect of administration of outpatient misoprostol on delivery outcomes and length of inductions. The electronic medical record was used to document deliveries in which women received outpatient misoprostol before a formal inpatient induction or received misoprostol only as an inpatient. Unadjusted and adjusted statistical analyses were used to compare Bishop Scores, induction time (admission to delivery), length of stay, birth weight, gestational age, cesarean section rate, complications, and cancellation of induction due to labor between the two cohorts. Of the 5885 women with live deliveries, 296 were given outpatient misoprostol (25 μg orally), and 5589 were given misoprostol only as an inpatient. There were no differences in induction time or length of stay between the two groups. Birth weight and gestational age were higher in the outpatient misoprostol group, and this difference was sustained after adjusting for confounding variables. Outpatient misoprostol was associated with increased adjusted odds of canceling an induction due to labor (odds ratio [OR] 2.47; 95% confidence interval [CI] 1.26-4.83). There was no difference in the incidence of cesarean section (OR 1.16; 95% CI 0.81-1.66). The use of outpatient misoprostol is a safe and viable option for women requiring induction of labor and may be a useful adjunct for an busy unit.